Concierge hand & wrist surgery · UK
Private hand and wrist ligament reconstruction, by a BSSH consultant hand surgeon.
Scapholunate, lunotriquetral, TFCC, thumb UCL or DRUJ — the right procedure for the stage of your injury, in a proper day-case theatre, with hand therapy arranged from day one.
Why patients choose us
- 01
A BSSH hand surgeon, in a proper theatre
Not a general orthopod. A named consultant hand and wrist surgeon — BSSH-affiliated — with wrist arthroscopy on the table when it is the right call.
- 02
The right procedure for the stage of injury
Acute repair, capsulodesis, tendon reconstruction, TFCC repair, salvage fusion — each one has a window. We match the surgery to the stage, not the diary.
- 03
Hand therapy from the start
The difference between a good and a poor outcome. A specialist hand therapist is arranged before you leave theatre, not chased for weeks after.
Indicative pricing
What private hand and wrist ligament reconstruction costs in the UK.
Indicative ranges across our partner hand-and-wrist clinics. Send the details and we quote firm figures across two or three options.
In short
Ligament reconstruction in our network: £4,000–£12,000, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Acute SL repair (suture anchor + K-wires) | £4,500–£7,000 | 90 min | Day case |
| Dorsal capsulodesis (sub-acute SL) | £5,000–£7,500 | 90–120 min | Day case |
| Tendon reconstruction (Brunelli / ANAFAB / SLIC) | £7,500–£12,000 | 150–180 min | Day case |
| TFCC arthroscopic repair (Palmer 1B) | £4,000–£6,500 | 60–90 min | Day case |
| Thumb UCL repair (± palmaris graft) | £4,000–£6,500 | 60–90 min | Day case |
| Salvage 4-corner fusion or PRC | £8,000–£12,000 | 120–180 min | Day case |
| Consultation and MR arthrogram planning | £300–£900 | 45 min | Same week |
Prices vary by clinic, by which surgeon does the case, by anaesthetic (WALANT vs GA), and by whether a tendon graft or salvage procedure is needed. We come back with a firm quote within one working day.
The problem
The right surgeon, the right window, the right therapy.
Hand and wrist ligament injuries are quietly one of the most missed diagnoses in the UK — a wrist sprain that was actually an SL tear, a thumb strain that was a Stener lesion, an ulnar-sided wrist ache that was a TFCC. We fix all three: a BSSH surgeon, the right operative window, and hand therapy from the start.
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Told it is just a sprain?
An SL, LT, TFCC or Stener-lesion UCL tear can look like a sprain on plain X-ray. A dedicated hand assessment and MR arthrogram sorts it out.
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In the acute window?
The first six weeks are the best time to repair SL, LT and TFCC injuries. We move fast when the window is open.
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Chronic or already arthritic?
A tendon reconstruction, a salvage 4-corner fusion or PRC — each has its place. We match the operation to your wrist, not the diary.
The journey
From enquiry to hand therapy — what happens, in order.
One clinician from first message to review — including the hand-therapy window that decides the outcome.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Mechanism (fall, sport, twist), which side, how long, and what you can and cannot do with the hand.
- 02
Before
Assessment and imaging
Consultant review with Watson scaphoid shift, LT ballottement and TFCC fovea testing. X-ray for a Terry-Thomas SL gap or ring sign, then MR arthrogram — or wrist arthroscopy for a dynamic look.
- 03
Before
We agree the operation
Acute suture-anchor repair, capsulodesis, tendon reconstruction (Brunelli, ANAFAB, SLIC), TFCC repair or a salvage 4-corner fusion / PRC — with an indicative cost and dates.
- 04
On the day
Arrival at the clinic
Arrival, consent and a chat with the surgeon and anaesthetist. LA with WALANT, a regional block, or GA depending on complexity.
- 05
On the day
The procedure itself
60 to 180 minutes as a day case. Dorsal or volar approach, suture anchors and K-wires as needed, careful tendon harvest if a graft is planned, bespoke splint before you wake.
- 06
On the day
Home the same day
Recovery, written aftercare, and home within a few hours. With sedation or GA you will need someone to collect you and stay overnight.
- 07
After
Hand therapy and review
Splint from the therapist within days, K-wires out at 6–8 weeks, protected motion, and formal hand therapy for 3–6 months. Driving 6–12 weeks, sport 4–6 months.
Typical end-to-end: 2–3 weeks from enquiry to surgery. Formal hand therapy: 3–6 months.
When it helps
When ligament reconstruction is the right step.
The injury patterns we see most, plus the one red flag that means an emergency rather than an appointment.
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Scapholunate (SL) ligament tear
FOOSH injury with dorsal wrist pain, weak grip and a positive Watson shift — the commonest carpal ligament we reconstruct.
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Lunotriquetral (LT) ligament tear
Ulnar-sided wrist pain with a positive ballottement test — rarer than SL, but treated on similar principles.
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TFCC tear (Palmer / Atzei)
Ulnar-sided pain, clicking on rotation, fovea tenderness — peripheral 1B tears repair well arthroscopically.
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Thumb UCL — gamekeeper’s / skier’s
Forced thumb abduction (ski pole, football). A Stener lesion needs surgical repair — not a splint.
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DRUJ instability
Distal radioulnar joint instability from a TFCC foveal tear — TFCC repair or an Adams-Berger reconstruction with palmaris longus.
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Finger MCP / PIP collateral injury
Jammed or hyperextended finger with lateral instability — most settle with a splint, a minority need repair.
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Chronic instability with early arthritis
A missed SL injury heading toward SLAC wrist — salvage 4-corner fusion or PRC preserves useful motion.
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Red flag: open injury or dislocation
An open wound, obvious dislocation, or hand that is cold, pale or numb is an emergency — same-day A&E, not a clinic booking.
Procedure options
One diagnosis, several operations.
What each option on the table actually involves — and which fits which stage of injury.
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Acute SL repair (<6 weeks)
Dorsal approach, suture anchors into the scaphoid and lunate, K-wires across the SL joint for 6–8 weeks. The best window — do not miss it.
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Dorsal capsulodesis (sub-acute)
For SL tears 6 weeks to 6 months old that still reduce. The dorsal capsule is used as a check-rein, backed up with K-wires.
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Tendon reconstruction (chronic, reducible)
Modified Brunelli / three-ligament tenodesis (Garcia-Elias), ANAFAB, SLIC, RASL or SLAM — a tendon graft rebuilds a scapholunate link that is beyond repair.
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TFCC arthroscopic repair
Outside-in or all-inside repair of a peripheral (Palmer 1B) tear. Central 1A tears are debrided; a positive ulnar variance may need an ulnar-shortening osteotomy.
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Thumb UCL repair or reconstruction
Acute repair with a suture anchor and short thumb spica for 6 weeks. Chronic laxity is reconstructed with a palmaris longus graft.
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DRUJ / Adams-Berger reconstruction
A palmaris longus graft rebuilds the volar and dorsal radioulnar ligaments when TFCC repair alone is not enough.
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4-corner fusion or PRC (salvage)
For SLAC / SNAC wrist arthritis. Both preserve useful motion; the choice depends on cartilage at the capitate head and lunate fossa.
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WALANT — wide-awake, no tourniquet
Local anaesthetic with adrenaline, no tourniquet, no sedation. Increasingly the UK default for suitable soft-tissue hand cases — you go home fast.
Our vetted UK network
A small panel of hand surgeons, we picked them.
BSSH-affiliated consultant hand and wrist surgeons across London, the South East and the major regional centres. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every hand surgeon in our network.
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Consultant hand and wrist surgeons — BSSH-affiliated, not general orthopaedic trainees
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Wrist arthroscopy available for diagnosis and TFCC repair
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WALANT, regional block or GA all offered — the anaesthetic matched to the case
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A named specialist hand therapist arranged before you leave theatre
Safety and recovery
What to expect afterwards — honestly.
Ligament reconstruction is a common, safe day-case procedure. The things worth planning are the K-wire window, the hand-therapy programme, and knowing what is normal after.
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Stiffness is the commonest issue
Some loss of wrist or finger motion is expected — often 10–20% of the opposite side. Hand therapy from week one keeps it to a minimum.
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Stability is improved, not perfect
Ligament reconstruction restores stability well enough to work, drive and often return to sport — a fully "normal" wrist is not always the aim.
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K-wire and hardware irritation
Pins are usually left proud through the skin and removed in clinic at 6–8 weeks. Suture anchors stay in place unless they cause symptoms.
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Nerve and scar sensitivity
Sensory branches of the radial and ulnar nerves are close to the surgical field — a patch of numbness or a tender scar can persist for months.
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CRPS is rare but real
Complex regional pain syndrome affects around 2–5% of hand and wrist surgery patients. Early hand therapy and good pain control reduce the risk.
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Infection is uncommon
Deep infection is under 1% for a day-case case with prophylactic antibiotics. Redness, spreading pain or fever needs same-day contact.
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Late degenerative change
A chronic SL injury can progress to SLAC wrist over 20–30 years. Reconstruction aims to slow that clock, not always to stop it.
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Revision or eventual fusion
A minority of chronic reconstructions loosen with time and need revision — or a salvage 4-corner fusion / PRC further down the line.
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Red flags
A cold, pale or numb hand, uncontrolled bleeding, spreading redness or a fever after surgery are not normal — call the clinic or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the hand surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis, side and stage
Which ligament (SL, LT, TFCC, UCL, DRUJ), which side, and whether the injury is acute, sub-acute or chronic — this drives the choice of procedure.
- 02 Technique
Approach, fixation and any graft used
Dorsal or volar approach, arthroscopy or open, suture anchors, K-wires, capsulodesis, or tendon graft (palmaris longus, FCR strip).
- 03 Findings
Cartilage, DRUJ and associated injuries
The state of the cartilage at the scaphoid, lunate and capitate, DRUJ stability under direct testing, and any other ligaments found at operation.
- 04 Impression
Splint, K-wire out, therapy and driving
Read this first: which splint, when the K-wires come out, when hand therapy starts, and the return-to-drive and return-to-sport timeline.
Recognised by major UK insurers
Cover for hand and wrist ligament reconstruction varies by insurer and by mechanism — usually funded for acute traumatic tears, and often for chronic instability with a clear diagnosis. We confirm cover before booking.
Frequently asked
Everything we get asked about hand and wrist ligament surgery.
Quick answers on WALANT, cost, K-wires, hand therapy, driving and return to sport.
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What is hand and wrist ligament reconstruction?
Surgery to repair or rebuild the small ligaments that hold the bones of the hand and wrist together — most often the scapholunate (SL), lunotriquetral (LT), TFCC or thumb ulnar collateral ligament. It uses suture anchors, K-wires and, when the ligament is beyond repair, a tendon graft.
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How do I know if I need surgery or a splint?
Acute complete SL and LT tears, Stener-lesion thumb UCL injuries, and unstable peripheral TFCC tears do best with surgery — ideally within six weeks. Partial tears, MCP and PIP collateral sprains, and central TFCC tears usually respond to a hand-therapy splint programme first.
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What is WALANT and will I be awake?
WALANT — Wide-Awake Local Anaesthesia No Tourniquet — is local anaesthetic with adrenaline and no arm tourniquet. You are fully awake, feel no pain, and can move the tendons and ligaments on request so the surgeon can check the repair. It is now standard for many UK hand cases.
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How long does the operation take?
A TFCC arthroscopic repair or thumb UCL repair is around 60–90 minutes. A dorsal capsulodesis is 90–120 minutes. A three-ligament tenodesis, ANAFAB or salvage 4-corner fusion runs 120–180 minutes. All are day-case.
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How much does hand and wrist ligament surgery cost privately in the UK?
Roughly £4,000–£6,500 for a TFCC or thumb UCL repair, £4,500–£7,500 for an acute SL repair or capsulodesis, £7,500–£12,000 for a tendon-graft reconstruction or salvage fusion. Consultation and MR arthrogram planning £300–£900. We confirm firm figures within one working day.
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How long until I can drive and return to work?
Desk work in a splint within 1–2 weeks. Driving 6–12 weeks depending on the procedure and which hand. Manual work and contact sport at 4–6 months. Your surgeon and hand therapist sign each stage off — the timeline is not one-size-fits-all.
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Why is hand therapy so important?
Hand therapy is the single biggest predictor of a good outcome. A specialist hand therapist makes a bespoke thermoplastic splint, guides protected motion, prevents stiffness and manages scar and swelling. Skipping it is how good surgery ends in a poor result.
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What if my SL injury is old and the wrist is already arthritic?
If SLAC (scapholunate advanced collapse) has started, a ligament reconstruction is unlikely to help. A salvage procedure — proximal row carpectomy (PRC) or a 4-corner fusion — removes the worn joint and preserves useful motion, with good long-term pain relief for most patients.
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What are the risks?
Stiffness, incomplete stability, hardware or K-wire irritation, infection, sensory nerve injury, scar sensitivity, CRPS in 2–5%, late degenerative change, and a small chance of needing revision surgery or an eventual salvage fusion.
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When should I go to A&E rather than book a clinic?
An open wound, obvious dislocation, uncontrolled bleeding, a cold, pale or numb hand, or a suspected compartment syndrome (severe pain out of proportion, tight forearm) are all emergencies — same-day A&E, not a private booking.
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